In his essay, Don’t Mourn for Us, Jim Sinclair describes autism as a “way of being.” He maintains there is “no normal child hidden behind the autism” and that “it colors every experience, every sensation, perception, thought, emotion, and encounter, every aspect of existence.” In an attempt to appreciate the depth of Sinclair’s statements, this thesis approaches autism as a “way of being” through the psychoanalytic theory of Jacques Lacan. By applying Lacan’s conceptual framework to first-person writing and scientific research, I lay an interdisciplinary foundation for the case I make. Although this project requires significant conceptual scaffolding across different epistemological systems, I consider how Lacanian theory possesses a unique capacity to conceive of autism as a way of being and to open new ways of approaching the source material. Implicitly, Sinclair asks that we consider the question of what it means “to be” – autistic, neurotypical, or otherwise. I approach this from the premise that an individual exists as a thinking being, or a “subject.” Because psychoanalysis is concerned with the constitutive role of the unconscious in structuring consciousness, this thesis invests substantial space in consideration of how the Lacanian subject is oriented around a fundamental lack. To this end, I return frequently to Lacan’s concept of objet a, understood as a representative of the subject’s lack in the perceptual realm that is itself lacking. Further, Lacan’s unique interpretation of Freud consists in placing language as the ultimate mediating structure of subjectivity; it both generates lack and establishes a system for mitigating it. One’s way of being is always a way of being in language.1 Given the predominant roles of language and social communication impairments in the DSM-V diagnostic criteria for autism, a main goal of this project is to consider how an autistic way of being entails a unique structuration of lack.2 Autism and psychoanalysis share a history that extends back to the origins of the diagnosis. I explore this history with a focus on how different psychoanalytic theories conceptualize the autistic subject and to what extent they honor or undermine Sinclair’s position. Contemporary Lacanian thinkers of autism do both. Unique to Lacan’s structural approach, the concept of the Other is inclusive of a radical alterity, yet also the system of language, the body, and certain aspects of the maternal and paternal functions. The subject is unthinkable apart from the Other. I suggest an autistic way of being is discernible in the autistic subject’s relation to each aspect of the Other. I find support for this claim in recent sensorimotor research. Referred to loosely as the movement perspective, this research suggests that differences in how autistic individuals move and perceive others is a “unifying characteristic” of autism.3 Importantly, the movement perspective is proactively inclusive of first-person knowledge. Read through Lacan’s conceptual framework, movement differences address the underlying mechanism of the autistic subject’s relation to the Other, and thus its way of being. Most fundamentally, this thesis is a work of theory that attempts to articulate something universal about being a subject, without simultaneously eliding what is unique about being an autistic subject

The purpose of this study was to determine the contamination level of Campylobacterjejuni in chicken quarters. Ninety-seven thigh and breast samples were purchased from thee supermarkets (Publix, Winn- Dixie, and Sedano's) in Miami-Dade County, Florida over an eight-week period. The bacteria were removed from the chicken skin by shaking the sample in a sterile bag containing nutrient broth. This extract was enriched in thioglycollate broth and subcultured onto selective media, which were incubated for 48 hours under microaerophilic conditions. Suspected colonies that were positive for the four biochemical tests performed were considered C. jejuni. The overall rate of contamination was 62%. Publix had the highest rate of contamination, 72%. Winn-Dixie had a contamination rate of 66%. Sedano's had the lowest rate of contamination, 48%. These findings show that the current methods used in preparing chicken for retail sale is not sufficient to eliminate pathogens, including Campylobacter jejuni.

INTRODUCTION: Health professionals emphasize the importance of breastfeeding in the development of children up to 6-months of age. It is known that short chain volatile fatty acids (SCVFAs) are a byproduct of nutrient fermentation by gut microbiome. These SCVFAs interact with the gut/brain axis and are known to influence infant development. Therefore, a reflection of maternal gut microbiome could likely be found in breastmilk (BM) due to diffusion of SCVFAs across the gut wall into the blood. Previous research in our laboratory has shown differences in the SCVFA fecal fermentation profile between individuals with normal (N) versus overweight/obese (OWOB) body mass index (BMI). Therefore, our research question is: Is there a difference in the relative amount and diversity of SCVFAs in the BM of N compared to OWOB women? We hypothesized that women of N will have a more diverse SCVFA profile than OWOB women in their BM. BM samples (200 ml) were collected from 44 women (22 N (BMI 22.0) and 22 OWOB (BMI 33.7) p2 while OWOB participants had a pre-gravid BMI of greater than 25.0 kg/m2. To our knowledge, this is the first time that SCVFAs have been quantified in the milk of lactating women using GC with an FID detector. This data supports the argument that the pre-gravid BMI of a mother can correlate to the SCVFA profile of her BM. It is unknown if the concentration observed in the mother’s BM in this study has an influence on the neonate’s gut/brain axis and neurological signals, however, we have demonstrated that the SCVFA profile is more diverse in the N BMI mother. Further research is warranted on the influence of maternal BM SCVFA composition on the growth and neurological development of her infant.

<p>Increasingly over the last few decades, funders and academic institutions have promoted the idea of interdisciplinarity as a way of harnessing new knowledge and fostering innovation in science. This dissertation of 4 papers sought to articulate how interdisciplinarity is experienced by health researchers involved in interdisciplinary research and to develop and implement a literature-based, researcher-informed framework for assessing interdisciplinarity. Findings from Paper 1 suggested that interdisciplinary teams tend to be formed based on who can contribute tangible skills needed for answering the research question, however interpersonal factors (e.g. previous positive working relationship) also drive how teams are formed. Paper 2 involved the development of the Framework for Interdisciplinary Research Assessment (FIRA). The literature revealed limited empirical work related to interdisciplinary evaluation, however, a detailed list of issues and possible metrics for evaluation was compiled, and characteristics common to the structure-process-outcome framework of quality were used to conceptualize interdisciplinary health research evaluation. In Paper 3, interviews and a survey were used to populate the FIRA model. Overall, there was a sense that skills, personality, and knowledge were greater considerations than disciplinary affiliation. Paper 4 involved the application of social network analysis in order to understand knowledge sharing in an interdisciplinary team and results highlighted the important role of staff as conduits of information. Overall, findings indicated that though interdisciplinarity is valued conceptually, it can be challenging to operationalize in practice. The FIRA model offers a viable structured approach for teams to engage in formative and summative assessment of interdisciplinarity.</p> / Doctor of Philosophy (PhD)

A continuous need for blood products, specifically for those who require frequent transfusions, such as individuals with sickle cell disease, warrants the need for targeted interventions to increase blood donations from underrepresented populations. One population in particular, African Americans, only account for 1% of blood donors in the United States. Literature indicates numerous reasons why this population is underrepresented amongst donors, including fear, lack of knowledge about the blood donation, and specific to this population, lack of trust in the medical community. This study involves the development, implementation, and assessment of a targeted educational approach, incorporating the Theory of Planned Behavior and various teaching methods, to motivate African Americans non-donors to attempt to donate blood. Participants attended a 1-hour educational session where they completed two surveys, one before the session and one directly after. A third survey was completed 2 months after the session. Of the 155 individuals enrolled in the study, 142 subjects were included in the data analysis. Sixteen percent of the study participants presented to donate as a result of attending the educational session. This resulted in a statistically significantly higher proportion of African Americans presenting to donate than the current proportion in Virginia. Analysis of results from the first two surveys indicated that subjective norm and attitude were significant predictors of one’s intent to donate blood, while perceived behavioral control was not a factor. The educational session increased survey scores related to intent to donate in comparison to scores obtained prior to the session. While this study resulted in a significant proportion of new donors, there is still a need for interventions that will focus specifically on changing attitudes toward blood donation and a need for methods to motivate African Americans to educate individuals in the community on the importance of becoming blood donors.

Attention deficit hyperactivity disorder (ADHD) is a psychopathology commonly characterized by general inattentiveness and/or a lack of impulse control resulting in hyperactive tendencies. ADHD is estimated to cost the United States roughly $266 billion every year. ADHD is currently treated via medications, cognitive behavioral therapy, or more recently, neurofeedback. Neurofeedback – and biofeedback in general – is the process of providing a patient with information about autonomic bodily functions so that they may control said autonomic function. In the case of ADHD, neurofeedback focuses on reinforcing the behaviors and sensations associated with attentiveness. Currently however, neurofeedback systems are large and require a patient to travel to a clinic. Furthermore, the current offering of portable neuro/biofeedback devices do not have the technological capabilities to provide effective neurofeedback therapy. Current wearable tech devices – such as the Apple Watch and Samsung Gear – possess the technological capabilities to measure important bodily functions, and provide appropriate biofeedback therapy while remaining discrete and most importantly, portable.

The purpose of this study was to examine the experiences and perceptions of behavioral factors that contribute to successful weight loss in male bariatric patients. By analyzing participant experiences and perceptions, this study contributes to a better understanding of which factors are most important in the postoperative phase of gastric bypass in males owing to successful weight loss. Although there is a tremendous amount of quantitative research within the bariatric population, there is a significant gap within the qualitative literature as it relates to male outcomes. As such, by conducting interviews with 10 postoperative male gastric bypass patients, this study was able to further understand how and why these participants obtained successful weight loss. Furthermore, by identifying relevant categories and thematic responses from the participants, this study may serve future researchers in designing other qualitative studies that target best practices in males for successful weight loss outcomes. The findings of this study indicate that participants found greater weight loss success by following proper eating behaviors and engaging in physical activity whereas support group attendance was not found to be an important factor in successful weight loss. This study also revealed that follow up with the bariatric nurse coordinator was greatly viewed as a positive step in adjusting to lifestyle postsurgery. As such, this supportive role by the nurse coordinator may provide further impetus for the ways in which bariatric personnel interact with patients who might not always be able to see their surgeon for follow-up.

A retrospective chart review was conducted on pediatric patients at the Intermountain Cystic Fibrosis Center who had a percutaneous endoscopic gastrostomy (PEG) placed between 1993 and 1999. Height velocity improved significantly in the group of patients with a PEG placed; however, pulmonary function declined more significantly over time. Questionnaires regarding attitude toward PEG placement were sent to patients enrolled in accredited cystic fibrosis centers in the mountain west region and to their parents. The overall response rate was 54.25% for the PEG questionnaire and 24% for the non-PEG questionnaire. Ninety-six percent of the patients with a PEG reported that weight was a problem at time of placement, and 91% reported weight gain after PEG ill placement. Sixty-four percent of the patients with a PEG reported that they would have a PEG placed if they made the decision again. Of the patients without a PEG, 60.7% thought a PEG looked bad, and 59.2% would be embarrassed to have a PEG. Forty-nine percent of patients without a PEG expressed a lack of knowledge of the pros and cons of PEG placement and 35.4% had no opinion about their knowledge of PEGs. PEG placement can be beneficial in improving nutritional status. Optimal time for PEG placement may be earlier rather than after pulmonary function has declined. People with a PEG have felt positive toward placement, and those without a PEG seem to lack knowledge about the pros and cons of PEG placement.

Immunotherapy is a potent new treatment for non-small cell lung cancer. However, immunotherapy is much more expensive than many treatment alternatives. Previous cost-effectiveness analyses determined that nivolumab would be cost effective if it elicits a response rate greater than 20% (Sullivan et al., 2016), is given to all non-squamous and all PD-L1 positive squamous stage IV non-small cell lung cancer patients (Aguiar et al., 2016), or is 33% cheaper for PD-L1 positive patients or 45% cheaper for all patients (Matter-Walstra et al., 2017). This thesis analyzes these three studies and accounts for the effect that many responders survive much longer than those who respond to other treatments by modeling overall survival for patients on nivolumab with two regressions. These regressions estimate, that after 150 months, the value (in terms of life-years saved) of nivolumab is about four times greater than that of docetaxel. Depending on pricing strategy, nivolumab was found to cost either $1,000 less or $16,000 more per month of survival than docetaxel. These estimates differ considerably due to imprecision in price estimates. Because of this high degree of uncertainty, it is impossible to say whether or not nivolumab is cost effective. Due to the considerably longer average survival which results from nivolumab treatment and the ambiguous cost-effectiveness results, immunotherapy should be treated as a possibly cost-effective treatment. Further cost-effectiveness analyses will be necessary once future costs of immunotherapy can be better estimated.

Background: Many health care facilities enforce strict dress code policies prohibiting visible body modifications, including tattoos, piercings, and vibrant hair colors. As popularity of body modifications among young adults surges, facilities may be forced to adapt policies as these workers enter the workforce. While some evidence exists related to patient perceptions of health care workers with body modifications, there is little about how nursing students perceive them. This study aimed to describe undergraduate, pre-licensure nursing students’ perceptions of health care worker appearance on compassion, skill, knowledge, and trustworthiness. Methods: Using cross-sectional design, an on-line Likert-type survey was used to collect data from 137 undergraduate, pre-licensure nursing students in Northeast Tennessee. Participants viewed photos of male and female workers with various body modifications. Data were analyzed using descriptive and inferential statistics. Results: There were statistically significant differences between groups across all four variables. Male and female health care workers without body modifications were rated highest on all four variables. Male and female with tattoos were rated the second highest. Male and female with facial piercings were rated lowest. The female health care worker color, irrespective of body modification type, was rated higher than the male counterpart across all variables. Conclusion: Results suggest that nursing students may perceive health care workers without body modifications to be the most compassionate, skilled, knowledgeable, and trustworthy. Students may perceive tattoos as more acceptable in the workplace than facial piercings or vibrant hair colors. Students may perceive body modifications as more acceptable for females than males.